Breast Reconstructive Surgery Rates Up Since Law Required Insurance Coverage, Study Finds

May 7, 2013 — The number of breast cancer patients who underwent breast reconstruction has increased since the enactment of a 1998 federal law mandating insurance coverage of the procedure, according to a study published in the journal Cancer, Reuters reports.

Previous research has shown that women with private insurance are more likely than women with Medicaid or Medicare coverage to have reconstructive surgery after a mastectomy. In an effort to expand access to the procedure, lawmakers passed the Women's Health and Cancer Rights Act, which requires health insurance plans to cover reconstructive surgery if they cover mastectomies.

For the study, researchers at the University of Pennsylvania analyzed records of more than 168,000 breast cancer patients who received mastectomies between 2000 and 2009.

Overall, the number of women who had reconstructive surgery rose from about 13% in 2000 to 36% in 2009, the study found. The number of women with Medicaid coverage who had the surgery increased from about 5% in 2000 to 20% in 2009, while the percentage of Medicare beneficiaries who had reconstructive surgery rose from 4.3% to 12.3% during the same time period. Meanwhile, reconstructive surgery rates among privately insured women rose from 22.1% to 57.1%.

Researchers' Comments

The researchers noted that the sharpest increase in the proportion of women receiving reconstructive surgery was among Medicaid and Medicare beneficiaries, suggesting that the procedure's cost was an obstacle for low-income breast cancer patients before the law was enacted.

However, the law likely is only partially responsible for the increase, according to study author Rachel Kelz, an assistant professor of surgery at the University of Pennsylvania. Kelz said, "The utilization of reconstruction overall has increased over the study time period because surgical techniques have changed and we've also expanded the people that are eligible for reconstruction compared to what was possible even 10 years ago."

Rachel Yang, a medical student at the University of Pennsylvania who led the study, said one possible reason that women without private insurance have reconstructive surgery less often could be that doctors are not referring those women to get the procedure (Grens, Reuters, 5/3).